The Heart Healers: The Misfits, Mavericks, and Rebels Who Created the Greatest Medical Breakthrough of Our Lives
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At one time, heart disease was a death sentence. In The Heart Healers , world renowned cardiologist Dr. James Forrester tells the story of the mavericks and rebels who defied the accumulated medical wisdom of the day to begin conquering heart disease. By the middle of the 20th century, heart disease was killing millions and, as with the Black Death centuries before, physicians stood helpless. Visionaries, though, had begun to make strides earlier. On Sept. 7, 1895, Ludwig Rehn successfully sutured the heart of a living man with a knife wound to the chest for the first time. Once it was deemed possible to perform surgery on the heart, others followed. In 1929, Dr. Werner Forssman inserted a cardiac catheter in his own arm and forced the x-ray technician on duty to take a photo as he successfully threaded it down the vein into his own heart...and lived. On June 6, 1944 - D-Day - another momentous event occurred far from the Normandy beaches: Dr. Dwight Harken sutured the shrapnel-injured heart of a young soldier, saved his life and the term "cardiac surgeon" born. Dr. Forrester tells the story of these rebels and the risks they took with their own lives and the lives of others to heal the most elemental of human organs - the heart. The result is a compelling chronicle of a disease and its cure, a disease that is still with us, but one that is slowly being worn away by "The Heart Healers". Review: A wonderful story told well... - This review first appeared in the blog of the California Society of Anesthesiologists, CSA Online. “The Heart Healers: The Misfits, Mavericks, and Rebels Who Created the Greatest Medical Breakthrough of Our Lives” (St. Martin Press, September, 2015) by James Forrester, MD, is a new non-fiction book that tells the true story of progress in treating heart disease from the 1940’s to today. During a career spanning from the 1960s to the present, Dr. Forrester lived through and contributed to developments that dramatically altered our understanding and treatment of valve diseases, arrhythmias, congestive heart failure, and coronary artery disease. In this book, he blends the fascinating story of cardiology advances and discoveries with case histories of his own patients, including how their conditions were treated, and how their treatment would have differed as techniques of diagnosis and therapy improved. After medical school at the University of Pennsylvania, Dr. Forester completed a residency in internal medicine at UCLA-Harbor General Hospital, and a cardiology fellowship at Harvard’s Peter Bent Brigham Hospital (now Brigham and Women’s). In 1970, he joined the cardiology group at Cedars-Sinai Medical Center. In the ensuing years, he contributed to the development of bedside hemodynamic monitoring with the Swan-Ganz catheter, and co-invented the Diamond-Forrester method of probability analysis in coronary disease. He led the team that developed coronary angioscopy, among many other research projects, and served as Chief of the Division of Cardiology at Cedars-Sinai, where he continues today as Professor Emeritus. Heart surgery? Too dangerous Operating on the heart was considered too dangerous to attempt in the early 1940s, expected to produce massive bleeding and instant death. Then, a U.S. military surgeon stationed in a battlefield hospital in London during World War II confronted the challenge posed by shrapnel wounds in the hearts of young soldiers. Rather than accepting inevitable death from those injuries, he decided to remove the shrapnel and designed a technique to close the hole. Dramatically, his first success occurred on a date now celebrated in history — as D-Day, June 6, 1944. Willingness to challenge preexisting consensus, coupled with creativity, soon led to more complex cardiac surgeries. An operation to correct mitral valve stenosis came first, even before the invention of the heart-lung machine. That technological wonder enabled longer and more complicated operations — to correct congenital abnormalities, repair and replace heart valves, and finally to deal with the biggest killer of all, coronary artery disease (CAD). Dr. Forrester has a great story to tell, and he does it very well. It helps that his subjects include misfits and rebels like the resident who passed a urinary catheter from his own left antecubital vein to his heart, to test his hypothesis that cardiac catheterization could be done safely. His hospital’s head physician had forbidden the procedure, but the chief’s rage at the resident’s defiance was muted by the procedure’s success. By the 1950s, cardiologists were able to visualize the chambers of the heart by injecting contrast dye, but had no way to obtain images of the entire length of coronary arteries. Experts agreed that inserting a catheter into one of those vessels could completely obstruct it and lead to an infarct. Even if that didn’t happen, injecting dye into a coronary artery would deprive the heart of oxygenated blood, they believed, and lead to sudden death. Serendipity stepped in when an attempt to visualize an aortic valve went awry at the Cleveland Clinic in 1958. The catheter accidentally lodged in the patient’s right coronary artery. He suffered no lasting problems, but the procedure produced a clear image of the entire length of his coronary artery. That observation led to the development of coronary angiography, better diagnosis of coronary artery disease, and later to coronary artery bypass surgery. CAD: from death sentence to successful treatment In the mid-1960’s, when Dr. Forrester was a medical student, he recalled treating a patient who was admitted to a regular hospital bed with unstable angina. The symptoms inexorably progressed to myocardial infarction, hypotension, ventricular tachycardia, and ventricular fibrillation. The ensuing CPR ended in the patient’s demise. Only a few years later, Dr. Forrester notes, a patient like that would have been admitted to a coronary care unit with a bedside monitor to promptly detect arrhythmias, and treated with medicines to prevent the sequence of events that ensued. If the patient did go into v-fib, resuscitation would have been more prompt and his chances for survival would have been much better. By the 1980’s, the sudden onset of ECG changes of a heart attack on a bedside monitor would have led to treatment with an intravenous clot buster. Later, coronary angioplasty improved on those results. Along the way, cardiologists also made progress in lowering the risk of CAD with statins and other drugs. The Heart Healers covers the period of greatest progress in the history of heart medicine through the stories of clinicians, scientists and patients who contributed to and benefited from these developments. Dr. Forester writes clearly enough to be understood by lay readers, but relates enough fascinating anecdotes and historical vignettes to entertain and inform experienced physicians as well. Review: History in Our Lifetime - My wife had a double heart valve replacement this year. I was staggered by the complexity of the procedure, the intensity of post-op monitoring, and the challenges of recovery and rehabilitation. So, I approached The Heart Healers with more than casual interest. This beautifully written book covers the history of cardiology’s golden age. For a history, it is short but eventful. In the seventy-five years since Dwight Harken’s removal of shrapnel from a WW II soldier’s heart, the field has propelled forward with a justifiable sense of urgency. It is rare that a historian is positioned to write in the first person. But because author James S. Forrester, himself a pioneering cardiologist, personally knew of these historical contemporaries, he was able to relate their personalities and motivations. One, experiencing failure after failure, continued to schedule experimental surgeries until the hospital suspended his privileges. Another, afflicted with the “pain of the pioneer,” abruptly quit the profession after two failed childhood surgeries. A third, exhibiting the brio that led to his medical breakthroughs, wound up in prison. But this steadfastness also led these remarkable innovators to follow their crazy-sounding visions and persist beyond reason to realize astounding medical breakthroughs. Once struck with a notion of the possible, they were willing to struggle through unimaginable failures. So, the book’s subtitle, “Misfits, Mavericks, and Rebels,” accurately characterizes these personalities. Forrester’s insightful statements attest to the nature of innovation. He often states: “Chance favors the prepared mind,” and claims that pioneers won’t get it right the first time, but they will learn from their mistakes. Advancement is not a smooth progression; each step is built on painful failures. Forrester writes with the precision of a surgeon and the compassion of one who loves his profession. He is able to introduce a sense of drama beyond the cool demeanor of a heart doctor. He walks the reader through the profession’s advances, where complex problems are solved at each step. Early mainstay solutions included heart-lung bypass machines, defibrillators, and pacemakers. By the early 1960s, surgeons turned their attention to heart failures caused by heart valve disease and heart muscle scarring from heart attacks. Diagnostic capabilities emerged, such as the Cardiac Cath Lab and the Coronary Care Unit (CCU) where heart patients could get specialized care. Stents were developed to repair coronary artery narrowing, and balloon angioplasty was used to prevent re-narrowing. More sophisticated artificial valves were developed. And, the application of balloon angioplasty to valve replacement led to TAVR, an aortic valve replacement procedure using a catheter-mounted stent with an artificial valve. A section was devoted to the heart transplant “space race,” with the contrasting episodes of Christiaan Barnard in South Africa, and Norman Shumway at Stanford. Attention also focused on a growing killer – coronary artery disease (CAD). While surgical procedures such as coronary bypasses had advanced, CAD causes and prevention were not well understood. New insights were needed. The community learned about the dangers of cholesterol deposits (plaques) on the walls of coronary arteries. They studied how LDL (“bad”) cholesterol was formed and developed drugs to inhibit it. The importance of a heart-healthy diet was confirmed. At this point, the book subtly turned to the reader’s health. The author leverages his knowledge on plaque formation to describe preventative behaviors involving diet, exercise, and the use of statin drugs. For all of the book’s technological advances, in the end our heart health custodianship is returned to us. Forrester concludes by reflecting on his earlier experiences and lamenting for those who were born too soon to benefit from these achievements.
| Best Sellers Rank | #748,186 in Books ( See Top 100 in Books ) #343 in Cardiology (Books) #344 in Cardiovascular Diseases (Books) #577 in History of Medicine (Books) |
| Customer Reviews | 4.7 out of 5 stars 246 Reviews |
A**A
A wonderful story told well...
This review first appeared in the blog of the California Society of Anesthesiologists, CSA Online. “The Heart Healers: The Misfits, Mavericks, and Rebels Who Created the Greatest Medical Breakthrough of Our Lives” (St. Martin Press, September, 2015) by James Forrester, MD, is a new non-fiction book that tells the true story of progress in treating heart disease from the 1940’s to today. During a career spanning from the 1960s to the present, Dr. Forrester lived through and contributed to developments that dramatically altered our understanding and treatment of valve diseases, arrhythmias, congestive heart failure, and coronary artery disease. In this book, he blends the fascinating story of cardiology advances and discoveries with case histories of his own patients, including how their conditions were treated, and how their treatment would have differed as techniques of diagnosis and therapy improved. After medical school at the University of Pennsylvania, Dr. Forester completed a residency in internal medicine at UCLA-Harbor General Hospital, and a cardiology fellowship at Harvard’s Peter Bent Brigham Hospital (now Brigham and Women’s). In 1970, he joined the cardiology group at Cedars-Sinai Medical Center. In the ensuing years, he contributed to the development of bedside hemodynamic monitoring with the Swan-Ganz catheter, and co-invented the Diamond-Forrester method of probability analysis in coronary disease. He led the team that developed coronary angioscopy, among many other research projects, and served as Chief of the Division of Cardiology at Cedars-Sinai, where he continues today as Professor Emeritus. Heart surgery? Too dangerous Operating on the heart was considered too dangerous to attempt in the early 1940s, expected to produce massive bleeding and instant death. Then, a U.S. military surgeon stationed in a battlefield hospital in London during World War II confronted the challenge posed by shrapnel wounds in the hearts of young soldiers. Rather than accepting inevitable death from those injuries, he decided to remove the shrapnel and designed a technique to close the hole. Dramatically, his first success occurred on a date now celebrated in history — as D-Day, June 6, 1944. Willingness to challenge preexisting consensus, coupled with creativity, soon led to more complex cardiac surgeries. An operation to correct mitral valve stenosis came first, even before the invention of the heart-lung machine. That technological wonder enabled longer and more complicated operations — to correct congenital abnormalities, repair and replace heart valves, and finally to deal with the biggest killer of all, coronary artery disease (CAD). Dr. Forrester has a great story to tell, and he does it very well. It helps that his subjects include misfits and rebels like the resident who passed a urinary catheter from his own left antecubital vein to his heart, to test his hypothesis that cardiac catheterization could be done safely. His hospital’s head physician had forbidden the procedure, but the chief’s rage at the resident’s defiance was muted by the procedure’s success. By the 1950s, cardiologists were able to visualize the chambers of the heart by injecting contrast dye, but had no way to obtain images of the entire length of coronary arteries. Experts agreed that inserting a catheter into one of those vessels could completely obstruct it and lead to an infarct. Even if that didn’t happen, injecting dye into a coronary artery would deprive the heart of oxygenated blood, they believed, and lead to sudden death. Serendipity stepped in when an attempt to visualize an aortic valve went awry at the Cleveland Clinic in 1958. The catheter accidentally lodged in the patient’s right coronary artery. He suffered no lasting problems, but the procedure produced a clear image of the entire length of his coronary artery. That observation led to the development of coronary angiography, better diagnosis of coronary artery disease, and later to coronary artery bypass surgery. CAD: from death sentence to successful treatment In the mid-1960’s, when Dr. Forrester was a medical student, he recalled treating a patient who was admitted to a regular hospital bed with unstable angina. The symptoms inexorably progressed to myocardial infarction, hypotension, ventricular tachycardia, and ventricular fibrillation. The ensuing CPR ended in the patient’s demise. Only a few years later, Dr. Forrester notes, a patient like that would have been admitted to a coronary care unit with a bedside monitor to promptly detect arrhythmias, and treated with medicines to prevent the sequence of events that ensued. If the patient did go into v-fib, resuscitation would have been more prompt and his chances for survival would have been much better. By the 1980’s, the sudden onset of ECG changes of a heart attack on a bedside monitor would have led to treatment with an intravenous clot buster. Later, coronary angioplasty improved on those results. Along the way, cardiologists also made progress in lowering the risk of CAD with statins and other drugs. The Heart Healers covers the period of greatest progress in the history of heart medicine through the stories of clinicians, scientists and patients who contributed to and benefited from these developments. Dr. Forester writes clearly enough to be understood by lay readers, but relates enough fascinating anecdotes and historical vignettes to entertain and inform experienced physicians as well.
D**D
History in Our Lifetime
My wife had a double heart valve replacement this year. I was staggered by the complexity of the procedure, the intensity of post-op monitoring, and the challenges of recovery and rehabilitation. So, I approached The Heart Healers with more than casual interest. This beautifully written book covers the history of cardiology’s golden age. For a history, it is short but eventful. In the seventy-five years since Dwight Harken’s removal of shrapnel from a WW II soldier’s heart, the field has propelled forward with a justifiable sense of urgency. It is rare that a historian is positioned to write in the first person. But because author James S. Forrester, himself a pioneering cardiologist, personally knew of these historical contemporaries, he was able to relate their personalities and motivations. One, experiencing failure after failure, continued to schedule experimental surgeries until the hospital suspended his privileges. Another, afflicted with the “pain of the pioneer,” abruptly quit the profession after two failed childhood surgeries. A third, exhibiting the brio that led to his medical breakthroughs, wound up in prison. But this steadfastness also led these remarkable innovators to follow their crazy-sounding visions and persist beyond reason to realize astounding medical breakthroughs. Once struck with a notion of the possible, they were willing to struggle through unimaginable failures. So, the book’s subtitle, “Misfits, Mavericks, and Rebels,” accurately characterizes these personalities. Forrester’s insightful statements attest to the nature of innovation. He often states: “Chance favors the prepared mind,” and claims that pioneers won’t get it right the first time, but they will learn from their mistakes. Advancement is not a smooth progression; each step is built on painful failures. Forrester writes with the precision of a surgeon and the compassion of one who loves his profession. He is able to introduce a sense of drama beyond the cool demeanor of a heart doctor. He walks the reader through the profession’s advances, where complex problems are solved at each step. Early mainstay solutions included heart-lung bypass machines, defibrillators, and pacemakers. By the early 1960s, surgeons turned their attention to heart failures caused by heart valve disease and heart muscle scarring from heart attacks. Diagnostic capabilities emerged, such as the Cardiac Cath Lab and the Coronary Care Unit (CCU) where heart patients could get specialized care. Stents were developed to repair coronary artery narrowing, and balloon angioplasty was used to prevent re-narrowing. More sophisticated artificial valves were developed. And, the application of balloon angioplasty to valve replacement led to TAVR, an aortic valve replacement procedure using a catheter-mounted stent with an artificial valve. A section was devoted to the heart transplant “space race,” with the contrasting episodes of Christiaan Barnard in South Africa, and Norman Shumway at Stanford. Attention also focused on a growing killer – coronary artery disease (CAD). While surgical procedures such as coronary bypasses had advanced, CAD causes and prevention were not well understood. New insights were needed. The community learned about the dangers of cholesterol deposits (plaques) on the walls of coronary arteries. They studied how LDL (“bad”) cholesterol was formed and developed drugs to inhibit it. The importance of a heart-healthy diet was confirmed. At this point, the book subtly turned to the reader’s health. The author leverages his knowledge on plaque formation to describe preventative behaviors involving diet, exercise, and the use of statin drugs. For all of the book’s technological advances, in the end our heart health custodianship is returned to us. Forrester concludes by reflecting on his earlier experiences and lamenting for those who were born too soon to benefit from these achievements.
A**D
The soon-to-be-deposed Emperor of All Maladies is heart disease
As a doctor, I am drawn to non-fiction books about medicine written in lay language. My all-time favorite is Siddhartha Mukherjee’s Emperor of All Maladies, the biography of cancer. James Forrester’s Heart Healers now sits beside it on my shelf of medical classics. It is the Emperor’s bookend, written about heart disease. Forrester’s book is an unvarnished eyewitness to an incredible era of history, since he was both an observer and an important participant in what he calls “the greatest medical breakthrough of our times.” While that title initially smacks of potential whopping overstatement, I believe most readers as they read the last page will take a deep breath and say to themselves “that’s a truly amazing story.” What makes Forrester’s story unique is that it reads just like page-turning mystery-thriller fiction. Because we are constantly asking ourselves what’s going to happen next, it’s difficult to put down. Combine that with the fact that as the story catapults forward, he unfolds a drama of dying real people snatched back from death and heartbreaking stories of real lives lost. Over and over I found myself “choked up” as I became involved in his patient stories. In the midst of the tumult and chaos of medical success and failure that he describes stands a group of doctors he labels “mavericks and misfits.” As I was swept along from one insurmountable problem to another amazing solution, I had not the slightest doubt that this part of the title Forrester chose for his book is also spot on. Without pushing the point or making judgments, he makes a compelling case that the cascade of breakthroughs he describes were driven by doctors whose creativity seemed closely linked to their sometimes egregious risk-taking and their rebellious natures. In addition to his terrific story, as a doctor I also appreciate how Forrester, like Mukherjee, often gently plants profound ideas and questions for the general public to think about. Among these ideas are that people “always” die in the course of medical progress, and that we learn more from our mistakes than our successes. Another intriguing unanswered question is whether the astonishing medical advances he describes could occur in today’s regulatory environment. As he enters the present and future, Forrester offers one final provocative question: could heart disease, which currently rules the roost as our nation’s number one killer, be deposed by the end of this decade? He says it will and he tells us why. Comparing these two outstanding books, each has its special merits. I would say Mukherjee’s writing is somewhat more scholarly and literary with interesting metaphors, Forrester’s writing has more dramatic tension and pace, and his characters are quite a bit more emotionally engaging. The importance of Forrester’s topic, the drama that percolates through every page, and the simplicity and clarity of his explanations for a lay reader make Heart Healers the best medical book that I have read.
W**Y
Interesting book
Very interesting about all the advances and reversals and the major surgeons advancing the rules on what you can and cannot do to the heart. It wasn't the book I had been searching for about how someone said the heart didn't pump the blood buwas the recipient
D**R
Can medical non-fiction be this fascinating? YES!!!
If you have even the slightest interest in medicine or medical history OR have heart disease and would like to understand how much and HOW progress has been made in this field, you will thoroughly enjoy this book! It is non-fiction which reads like the most exciting medical fiction book you can imagine. The stories of the technological advances and the personal grit, determination, and brilliance that led to them will amaze you. There will be times when your jaw drops- the stories just seem unreal. You will be seized by the awe of it all and, sometimes, the tragedy of it as life stories of these giants are told. This book is written by someone who contributed greatly to this field and knew many of the giants he talks about as friends. There are some incredible stories that were left out- the prominent cardiologist who discovered that a widely publicized and very profitable medication actually resulted in cardiac events and death and SAID something loudly and publicly and effectively, thereby losing the career he had at the time (although he has gone on to play an even more prominent role in medicine) is one story that speaks of the finest in medicine (there are many others). This book is a really wonderful contribution to understanding the incredible science and doctors (including Dr. Forrester) who have advanced the technology and science of cardiovascular medicine and surgery. Well written, you will not want to put this book down! It is THAT interesting!!! The final chapters which explain how all this knowledge can be used by the reader and his/her family and friends to avoid cardiovascular disease is the icing on the cake of this masterpiece. Anyone with an interest in science and medicine will find this to be one of the most fascinating books he/she has ever read (right up there with the Emperor of All Maladies)!
R**.
After the indescribably wonderful "The Emperor of All Maladies"
After the indescribably wonderful "The Emperor of All Maladies", I thought that no work about medicine-or of any topic-could reach the pinnacle of writing reached by Dr. Mukherjee. In fact, I thought it would be foolish even to try. Dr. Forrester has done it. While taking nothing away from "The Emperor..",Dr. Forrester matches the beauty of the story telling in Dr. Mukherjee's remarkable work. As with "The Emperor..", I am urging everyone I know-inside and outside of medicine- who loves a gripping and meaningful story to read "The Heart Healers". The entry into the two stories is interstingly different. With "The Emperor..", an avid reader cannot put the book down after reading the first page. With "The Heart Healers", a beautifully well done introduction is made to introduce the reader to the anatomy and physiology of the heart and the cardiovascular system; and then...boom!...the stories start and keep on coming. You Amazon readers who take the time to study works of this magnitude are very special people. You have a thirst for knowledge, an ear for storytelling and a fascination for beautiful writing. "The Heart Healers" by James Forrester was written for you. Robert C. Henry, M.D. Emergency Physician
J**D
Dr. Forrester - Thank you for writing this book!
During this past year I've read about a dozen books about cardiac medicine. I was diagnosed with coronary artery disease a year ago, and I wanted to learn why it happened and if it was a curable illness. Dr. Forrester's well written and knowledgeable history of the development of cardiac medical care helped this layman understand today's most common self-induced disease. He tells the compelling history of cardiac medicine illustrating the development of procedures and advancements through his patient's and his own case histories. His many personal associations with the pioneers of cardiac care make this an enlightening autobiographical journey from WWII to the present. My copy of his book is full of sticky notes and underlined passages. Whenever anyone asks me about my own situation, I refer them to this book and urge them to read it carefully. I will become a classic in the field of cardiac care and history. Dr. Forrester - Thank you for taking the time to write this book!
K**D
Forrester allowed me to better understand what all she went through and what more ...
I purchased this Kindle book because I am interested in medical history, but I also had a more personal reason as well. In early 2015, I lost my Mom 13 days after she'd had open-heart surgery to replace a valve. While I didn't expect it, Dr. Forrester allowed me to better understand what all she went through and what more than likely ultimately led to her death. There were just several clues peppered throughout the book that allowed me to check off, mentally, what may have happened. It allowed me to gain further peace about it all. I also give Dr. Forrester kudos for writing a book that gives details, without going into morbid descriptions of the surgeries, techniques, nor when things really went wrong for heart surgery pioneers. He gives you just enough of an idea without grossing you out! If you have a squeamish stomach, like I do, trust me, you can handle this book! It's all extremely interesting!
A**R
Storia della cardiologia moderna.
Gran libro…almeno per un cardiologo. Molto piacevole da leggere.
A**R
GREAT INSPIRATIONAL book has written by Dr James Forrester
GREAT INSPIRATIONAL book has written by Dr James Forrester, MD, a pioneer in medicine, cardiology. In his "THE HEART HEALERS" book, Dr. James Forrester, a world-renowned cardiologist, has begun writing each chapter by inserting inspiring quote - an eloquent author in medical science! This is captivating and enthralling style of writing.....those are in resource-poor developing nations - they would be inspired to create new knowledge in medicine, they would be inspired to find ways to bypass the existing expensive models and embark on cost-effective models for their patients and for patients globally. Thanks to Dr James Forrester.....
S**E
Großartig.
Großartig! Es ist fesselnd, unterhaltsam und informativ zugleich. Wer auch immer an der Geschichte der Kardiologie/Herz-Thorax-Chirurgie Interesse hat, der ist mit diesem Buch bestens beraten. Wirklich ausgezeichnet. Hatte mir das Buch aufgrund einer Empfehlung meines Professors in Kardiologie gekauft und definitiv nicht bereut.
A**S
wonderful story
Gave it to my father who is a cardiologist. He enjoyed it.
M**E
Five Stars
Excellent book
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